Glucocorticoids—All-Rounders Tackling the Versatile Players of the Immune System

Glucocorticoids regulate fundamental processes of the human body and control cellular functions such as cell metabolism, growth, differentiation, and apoptosis. Moreover, endogenous glucocorticoids link the endocrine and immune system and ensure the correct function of inflammatory events during tissue repair, regeneration, and pathogen elimination via genomic and rapid non-genomic pathways. Due to their strong immunosuppressive, anti-inflammatory and anti-allergic effects on immune cells, tissues and organs, glucocorticoids significantly improve the quality of life of many patients suffering from diseases caused by a dysregulated immune system. Despite the multitude and seriousness of glucocorticoid-related adverse events including diabetes mellitus, osteoporosis and infections, these agents remain indispensable, representing the most powerful, and cost-effective drugs in the treatment of a wide range of rheumatic diseases. These include rheumatoid arthritis, vasculitis, and connective tissue diseases, as well as many other pathological conditions of the immune system. Depending on the therapeutically affected cell type, glucocorticoid actions strongly vary among different diseases. While immune responses always represent complex reactions involving different cells and cellular processes, specific immune cell populations with key responsibilities driving the pathological mechanisms can be identified for certain autoimmune diseases. In this review, we will focus on the mechanisms of action of glucocorticoids on various leukocyte populations, exemplarily portraying different autoimmune diseases as heterogeneous targets of glucocorticoid actions: (i) Abnormalities in the innate immune response play a crucial role in the initiation and perpetuation of giant cell arteritis (GCA). (ii) Specific types of CD4+ T helper (Th) lymphocytes, namely Th1 and Th17 cells, represent important players in the establishment and course of rheumatoid arthritis (RA), whereas (iii) B cells have emerged as central players in systemic lupus erythematosus (SLE). (iv) Allergic reactions are mainly triggered by several different cytokines released by activated Th2 lymphocytes. Using these examples, we aim to illustrate the versatile modulating effects of glucocorticoids on the immune system. In contrast, in the treatment of lymphoproliferative disorders the pro-apoptotic action of glucocorticoids prevails, but their mechanisms differ depending on the type of cancer. Therefore, we will also give a brief insight into the current knowledge of the mode of glucocorticoid action in oncological treatment focusing on leukemia

GESTÃO DE INDICADORES FARMACÊUTICOS APLICADOS A FARMÁCIA ESCOLA EM JOINVILLE-SC

The Pharmacy School (Farmácia Escola - FAE) is a partnership between teaching, service and community created to develop the pharmaceutical profession and serve the users of the Brasilian Unified Health System in the dispensing of medicines. The present work aimed to analyze the pharmaceutical indicators from Pharmacy School, in order to account for the data and identify improvements or changes to promote the quality of the service provided. A qualitative and quantitative retrospective study was carried out from January 2014 to December 2018. The indicators of 'reception attendance', 'e-mail attendance', 'total dispensing attendance', 'dispensing schedules' , 'missed users', 'missing patient care', 'total dispensing care', 'total FAE care', and 'CEAF active patients'. The total number of visits performed at the FAE between 2014 and 2018 was 745,406, with a monthly average of 12,423. Absenteeism was observed in the proportion of 13.1%, but there was a significant increase in the mode of attendance performed by e-mail, proving that this is an increasing tool in the user's service. The results showed that the indicators are excellent management tools and that a continuous evaluation is necessary to improve the processes and management of the FAE.La Farmacia Escuela (Farmácia Escola ”“ FAE) es una asociación entre enseñanza, servicio y comunidad creada para desarrollar la profesión farmacéutica y atender a los usuarios del Sistema Único de Salud Brasileño en la dispensación de medicamentos. El presente trabajo tuvo como objetivo analizar los indicadores farmacéuticos de la Farmacia Escuela, a fin de contabilizar los datos e identificar mejoras o alteraciones para promover la calidad del servicio prestado. Se realizó una encuesta cuali-cuantitativa retrospectiva del período de enero de 2014 a diciembre de 2018. Se analizaron los indicadores de 'atención de la recepción', 'atendimientos por e-mail', 'total de atenciones de la dispensación' 'programaciones para dispensación' "usuarios que faltaron el día programado", "atención de usuarios faltantes (encajes) ',' total de atenciones de la dispensación ',' total de atenciones de la FAE ', y' pacientes activos CEAF '. El número total de atendimientos realizados en la FAE entre 2014 y 2018 fue de 745.406, con promedio mensual de 12.423. El absentismo fue observado en la proporción del 13,1%, pero hubo un aumento importante en la modalidad de atendidas realizadas por e-mail, demostrando que esta es una herramienta creciente en la atención del usuario. Los resultados mostraron que los indicadores son excelentes herramientas de gestión y que es necesaria una evaluación continuada para mejorar los procesos y la gestión de la FAE.A Farmácia Escola é uma parceria entre ensino, serviço e comunidade criada para desenvolver a profissão farmacêutica e atender os usuários do Sistema Único de Saúde na dispensação de medicamentos. O presente trabalho teve como objetivo analisar os indicadores farmacêuticos da Farmácia Escola, a fim de contabilizar os dados e identificar melhorias ou alterações para promoção da qualidade do serviço prestado. Foi realizada uma pesquisa quali-quantitativa retrospectiva do período de janeiro de 2014 a dezembro de 2018. Foram analisados os indicadores de ‘atendimento da recepção’, ‘atendimentos por e-mail’, ‘total de atendimentos da dispensação’ ‘agendamentos para dispensação’, ‘usuários que faltaram no dia agendado’, ‘atendimento de usuários faltantes (encaixes)’, ‘total de atendimentos da dispensação’, ‘total de atendimentos da FAE’, e ‘pacientes ativos CEAF’. O número total de atendimentos realizados na FAE entre 2014 e 2018 foi de 745.406, com média mensal de 12.423. O absenteísmo foi observado na proporção de 13,1%, mas houve um aumento importante na modalidade de atendimentos realizados por e-mail, demostrando que esta é uma ferramenta crescente no atendimento do usuário. Os resultados mostraram que os indicadores são excelentes ferramentas de gerenciamento e que é necessária uma avaliação continuada para melhoria dos processos e da gestão da FAE